Provider Demographics
NPI:1225002389
Name:SUDAN, ARTHUR WAYNE (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:WAYNE
Last Name:SUDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7932
Mailing Address - Country:US
Mailing Address - Phone:254-537-6200
Mailing Address - Fax:254-537-6201
Practice Address - Street 1:301 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7932
Practice Address - Country:US
Practice Address - Phone:254-537-6200
Practice Address - Fax:254-537-6201
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123199505Medicaid
TX123199503Medicaid
TX123199503Medicaid
TX123199505Medicaid
TXC22392Medicare UPIN